Abstract Details

Title Predictive value of radiographic signs of raised intracranial pressure for the postoperative risk of recurrence of spontaneous cerebro-spinal fluid (CSF) leaks

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) P6 - Poster Session 6 (12:00 PM-1:00 PM)

Poster/Presentation
Number 5-003

Objective To assess whether radiographic signs of increased intracranial pressure are predictors of postoperative recurrence of spontaneous CSF leaks.

Background A relationship between idiopathic intracranial hypertension (IIH) and spontaneous skull base CSF leaks has been proposed by which the CSF leak acts as a release valve, decreasing ICP, improving symptoms and signs (papilledema) of elevated ICP, and making the diagnosis of IIH challenging. When a CSF leak in patients with undiagnosed IIH is repaired, the patient is at risk of developing papilledema, symptoms of elevated ICP, or a recurrent CSF leak, making management and treatment difficult.

Design/Methods Retrospective review of demographics, fundus examination and pre-surgical brain MRI and MRV findings in patients seen in our neuro-ophthalmology clinic from October 2013 to September 2019 with a spontaneous CSF leak repair performed at our institution.

Results 72 CSF leak patients (median [interquartile range, IQR]: 51 [46-63] years; BMI:36 [22-63] kg/m²; 94% women; 58% black; 11% with known preexistent IIH) with brain MRI and MRV were systematically reviewed. Bilateral transverse venous sinus stenoses (TVSS) were more frequent (83% versus 49%, p=0.02) and the degree of stenosis was higher (median: 65% versus 10%, p=0.01) in patients with either papilledema or recurrent CSF leak. Of these 72 patients, 60 had a CSF leak repair without prior or simultaneous CSF diversion procedure, and 11 had a recurrence; patients with TVSS were 8.2 times (95% confidence interval: 1.35-157.8) more likely to develop a recurrence (p=0.05) after a median follow-up of 7.7 [2.0-16.2] months.

Conclusions CSF leak patients who develop papilledema or a recurrent CSF leak following repair of spontaneous CSF leak have a higher prevalence of bilateral TVSS and a higher degree of stenosis. Brain MRV is warranted preoperatively for decision-making, as bilateral TVSS is a risk factor for postoperative CSF leak recurrence.

Authors/Disclosures
Bryce Buchowicz, MD (University of Florida Health Center- The Oaks) PRESENTER	Dr. Buchowicz has nothing to disclose.
Amit Saindane	No disclosure on file
	No disclosure on file
Benson Chen, PhD FRACP (Department of Neurology, Auckland City Hospital)	Dr. Chen has nothing to disclose.
Nancy J. Newman, MD, F�鶹��ýӳ�� (Emory University School of Medicine)	Dr. Newman has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for GenSight. Dr. Newman has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Chiesi. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Stoke. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eli Lilly. Dr. Newman has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Phelcom. The institution of Dr. Newman has received research support from GenSight. Dr. Newman has received publishing royalties from a publication relating to health care. Dr. Newman has received publishing royalties from a publication relating to health care. Dr. Newman has received publishing royalties from a publication relating to health care.
Valerie Biousse, MD	Dr. Biousse has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gensights Biologic. Dr. Biousse has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Topcon. Dr. Biousse has received publishing royalties from a publication relating to health care. Dr. Biousse has received publishing royalties from a publication relating to health care.

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